by Proactive LTC Consulting | Sep 24, 2025 | ADR, Appeals, Compliance, Documentation, Medical Review, Reimbursement
SNF ADR Management: Prepare for Post-Probe Surge The SNF 5-Claim Probe & Educate officially ended on June 30, 2025, but for many providers, the scrutiny is just beginning. While CMS guidance indicates that providers with 100% error rates (5/5 claims in... by Proactive LTC Consulting | Jul 16, 2025 | ADR, Appeals, Audits, Documentation, Medical Review, Medicare, Reimbursement, SNF
Q: Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria? A: Unfortunately, yes — at least for now. Most managed care plans (including Medicare Advantage) still require prior... by Proactive LTC Consulting | Jul 2, 2025 | Compliance, MDS, Medical Review, Quality, Reimbursement
Top Nursing Home Missed Reimbursement Opportunities Practical Strategies to Capture What You’ve Rightfully Earned In today’s long-term care environment, nursing homes are under more pressure than ever to deliver high-quality care while navigating increasingly... by Proactive LTC Consulting | Apr 2, 2025 | Compliance, MDS, Medical Review, Medicare, PDPM, Reimbursement, Therapy
The State of SNF Medical Review in 2025: Trends, Challenges, and Key Findings Medical review of Skilled Nursing Facilities (SNFs) continues to be a focus of Medicare and Medicare Advantage oversight activities in 2025. With increased scrutiny from Medicare... by Proactive LTC Consulting | Dec 30, 2024 | Home Health, Medical Review
Home Health Survey Preparedness Survey windows are a source of anxiety for many home health operators. Ensuring your agency is consistently survey ready is imperative for survey success. Surveys must be unannounced, so home health agencies must always be... by Proactive LTC Consulting | Dec 30, 2024 | MDS, Medical Review, Medicare, SNF
Q: How can I ensure that claims are accurate prior to billing? A: The key to accurate claims submission is an effective Triple Check or Clean Claim review process. The Triple Check process is an interdisciplinary self-audit that aims to reduce the risk of...